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#coronavirus

Natural mood regulation low or even absent in people with depression

University of Oxford) Periods of lockdown during the COVID-19 situation likely to exacerbate problems with mood regulation, say experts at the University of Oxford.

Mood varies from hour-to-hour, day-to-day and healthy mood regulation involves choosing activities that help settle one’s mood. However, in situations where personal choices of activities are constrained, such as during periods of social isolation and lockdown, this natural mood regulation is impaired which might result in depression. New research, published today in JAMA Psychiatry, from the Department of Psychiatry, University of Oxford suggests a new target for treating and reducing depression is supporting natural mood regulation.

This new study looked at 58,328 participants from low, middle and high income countries, comparing people with low mood or a history of depression with those of high mood. In a series of analyses, the study investigated how people regulate their mood through their choice of everyday activities. In the general population, there is a strong link between how people currently feel and what activities they choose to engage in next. This mechanism — mood homeostasis, the ability to stabilise mood via activities — is impaired in people with low mood and may even be absent in people who have ever been diagnosed with depression.

Guy Goodwin, Professor Emeritus of Psychiatry, University of Oxford, said, ‘When we are down we tend to choose to do things that cheer us up and when we are up we may take on activities that will tend to bring us down. However, in our current situation with COVID-19, lockdowns and social isolation our choice of activity is very limited. Our research shows this normal mood regulation is impaired in people with depression, providing a new, direct target for further research and development of new treatments to help people with depression.’

One in five people will develop major depression at some point in their life. The current lockdown strategies used by different countries to control the COVID-19 pandemic is expected to cause even more depressions. About 50% of people will not see their symptoms improve significantly with an antidepressant and the same applies to psychological treatments. The total annual cost of depression in the UK is about £8 billion. A key priority for mental health research is therefore to develop new treatments or optimise existing ones for depression.

Maxime Taquet, Academic Foundation Doctor, University of Oxford, said, ‘By training people to increase their own mood homeostasis, how someone naturally regulates their mood via their choices of activities, we might be able to prevent or better treat depression. This is likely to be important at times of lockdown and social isolation when people are more vulnerable to depression and when choices of activities appear restricted. Our research findings open the door to new opportunities for developing and optimising treatments for depression and this could potentially be well adapted to treatments in the form of smartphone apps, made available to a large population which sometimes lack access to existing treatments.’

Using computer simulations, this study also showed that low mood homeostasis predicts more frequent and longer depressive episodes. Research suggests that by monitoring mood in real time, intelligent systems could make activity recommendations to increase mood regulation and such an intervention could be delivered remotely, improving access to treatment for patients for whom face-to-face care is unavailable, including low and middle income countries.

Importantly, some associations between activities and mood were highly culture-specific, for example, exercise led to the highest increase in mood in high income countries, whereas religion did so in low and middle income countries. Interventions aimed at improving mood regulation will need to be culture specific, or even individual specific, as well as account for people’s constraints and preferences.

On a global scale, more than 264 million people of all ages suffer from depression and the majority of cases, 80 per cent, are in low and middle income countries despite the scarcity of research performed in those countries. Major depressive disorder is a more important cause of disability worldwide than diabetes or lung cancer (in terms of disability-adjusted life years).

This research is supported by the NIHR Oxford Health Biomedical Research Centre and the Royal College of Psychiatrists

Top E.R. Doctor Who Treated Virus Patients Dies by Suicide

By  Ali WatkinsMichael RothfeldWilliam K. Rashbaum and Brian M. Rosenthal

A top emergency room doctor at a Manhattan hospital that treated many coronavirus patients died by suicide on Sunday, her father and the police said.

Dr. Lorna M. Breen, the medical director of the emergency department at NewYork-Presbyterian Allen Hospital, died in Charlottesville, Va., where she was staying with family, her father said in an interview.

Tyler Hawn, a spokesman for the Charlottesville Police Department, said in an email that officers on Sunday responded to a call seeking medical assistance.

“The victim was taken to U.V.A. Hospital for treatment, but later succumbed to self-inflicted injuries,” Mr. Hawn said.

Dr. Breen’s father, Dr. Philip C. Breen, said she had described devastating scenes of the toll the coronavirus took on patients.

“She tried to do her job, and it killed her,” he said.

The elder Dr. Breen said his daughter had contracted the coronavirus but had gone back to work after recuperating for about a week and a half. The hospital sent her home again, before her family intervened to bring her to Charlottesville, he said.

Dr. Breen, 49, did not have a history of mental illness, her father said. But he said that when he last spoke with her, she seemed detached, and he could tell something was wrong. She had described to him an onslaught of patients who were dying before they could even be taken out of ambulances.

“She was truly in the trenches of the front line,” he said.

He added: “Make sure she’s praised as a hero, because she was. She’s a casualty just as much as anyone else who has died.”

In a statement, NewYork-Presbyterian/Columbia used that language to describe her. “Dr. Breen is a hero who brought the highest ideals of medicine to the challenging front lines of the emergency department,” the statement said. “Our focus today is to provide support to her family, friends and colleagues as they cope with this news during what is already an extraordinarily difficult time.”

Dr. Angela Mills, head of emergency medical services for several NewYork-Presbyterian campuses, including Allen, sent an email to hospital staffers on Sunday night informing them of Dr. Breen’s death. The email, which was reviewed by The New York Times, did not mention a cause of death. Dr. Mills, who could not be reached for comment, said in the email that the hospital was deferring to the family’s request for privacy.

Aside from work, Dr. Breen filled her time with friends, hobbies and sports, friends said. She was an avid member of a New York ski club and traveled regularly out west to ski and snowboard. She was also a deeply religious Christian who volunteered at a home for older people once a week, friends said. Once a year, she threw a large party on the roof deck of her Manhattan home.

She was very close with her sisters and mother, who lived in Virginia.

One colleague said he had spent dozens of hours talking to Dr. Breen not only about medicine but about their lives and the hobbies she enjoyed, which also included salsa dancing. She was a lively presence, outgoing and extroverted, at work events, the colleague said.

NewYork-Presbyterian Allen is a 200-bed hospital at the northern tip of Manhattan that at times had as many as 170 patients with Covid-19, the illness caused by the coronavirus. As of April 7, there had been 59 patient deaths at the hospital, according to an internal document.

Dr. Lawrence A. Melniker, the vice chair for quality care at the NewYork-Presbyterian Brooklyn Methodist Hospital, said that Dr. Breen was a well-respected and well-liked doctor in the NewYork-Presbyterian system, a network of hospitals that includes the Columbia University Irving Medical Center and the Weill Cornell Medical Center.

“You don’t get to a position like that at Allen without being very talented,” he said.

Dr. Melniker said the coronavirus had presented unusual mental health challenges for emergency physicians throughout New York, the epicenter of the crisis in the United States.

Doctors are accustomed to responding to all sorts of grisly tragedies, he said. But rarely do they have to worry about getting sick themselves, or about infecting their colleagues, friends and family members.

And rarely do they have to treat their own co-workers.

Another colleague said that Dr. Breen was always looking out for others, making sure her doctors had protective equipment or whatever else they needed. Even when she was home recovering from Covid-19, she texted her co-workers to check in and see how they were doing, the colleague said.

[If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK) or go to SpeakingOfSuicide.com/resources for a list of additional resources. Here’s what you can do when a loved one is severely depressed.]

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